右美托咪定对老年全膝关节置换术患者术后恢复质量和脑电图的影响：一项随机临床试验。

IF 5.1 2区医学 Q1 CHEMISTRY, MEDICINAL

Drug Design, Development and Therapy Pub Date : 2025-08-29 eCollection Date: 2025-01-01 DOI:10.2147/DDDT.S536217

Hao Zhang, Yang Gao, Deng Liu, Wenhui Lyu, Xinyi Xing, Ziqing He, Lei Wang, Lei Zhang, Lijian Chen

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引用次数: 0

摘要

目的：老年全膝关节置换术（TKA）患者的麻醉管理策略对术后恢复质量（QoR）至关重要，麻醉药物相关的脑电图（EEG）变化可能在这一过程中起重要作用。本研究旨在探讨不同剂量右美托咪定对老年TKA患者术后QoR的影响，以及是否与特异性脑电图变化相关。方法：在本随机对照试验中，择期TKA的老年患者（年龄≥60岁）按1:1:1的比例随机分配至0.6 μg/kg/h右美托咪定（D2组）、0.3 μg/kg/h右美托咪定（D1组）和生理盐水（N组）。术后第1天和第3天，采用15项恢复质量（QoR-15）量表评价三组患者术后恢复情况。同时记录围术期脑电图数据。结果：D2组与N组术后第1天QoR-15评分差异显著（126[123-129]分vs 120[116-123]分，中位差6分[95% CI， 4 ~ 8], P < 0.001）， D2组与D1组(126[123-129]分vs 122[118-126]，中位差4分[95% CI， 2 ~ 5]；P = 0.001)，但D1组与n组没有差异。然而，术后第3天，三组间QoR-15总分和维度评分均无显著差异。术中脑电图功率谱分析显示，与n组相比，D1组和D2组α振荡峰值功率降低，慢振荡峰值功率升高，且术后第1天慢振荡峰值功率与QoR-15评分呈弱正相关（r = 0.319, P < 0.001）。结论：麻醉诱导前10分钟内给予右美托咪定负荷剂量（0.5 μg/kg），然后维持在0.6 μg/kg/h，可改善老年TKA患者术后第1天的QoR-15，这可能与右美托咪定通过在适当范围内增加慢振荡峰功率加深麻醉有关。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

Effects of Dexmedetomidine on Postoperative Quality of Recovery and Electroencephalogram in Elderly Patients Undergoing Total Knee Arthroplasty: A Randomized Clinical Trial.

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Effects of Dexmedetomidine on Postoperative Quality of Recovery and Electroencephalogram in Elderly Patients Undergoing Total Knee Arthroplasty: A Randomized Clinical Trial.

Purpose: Anesthesia management strategies in elderly patients undergoing total knee arthroplasty (TKA) are critical to the postoperative quality of recovery (QoR), and changes in electroencephalogram (EEG) associated with anesthesia drugs may play an important role in this process. This study aimed to determine the effects of different doses of dexmedetomidine on postoperative QoR in elderly TKA patients, and whether there is a correlation with specific EEG changes.

Methods: In this randomized controlled trial, elderly patients (aged ≥ 60 years) undergoing elective TKA were randomly allocated in a 1:1:1 ratio to 0.6 μg/kg/h dexmedetomidine (Group D2), 0.3 μg/kg/h dexmedetomidine (Group D1) and saline (Group N). On postoperative days 1 and 3, the15-item Quality of Recovery (QoR-15) scale was used to evaluate the postoperative recovery of patients among the three groups. Perioperative EEG data were also recorded.

Results: The difference of QoR-15 scores on postoperative day 1 was significant for Group D2 vs Group N (126 [123-129] points vs 120 [116-123] points; median difference, 6 points [95% CI, 4 to 8]; P < 0.001) and Group D2 vs Group D1 (126 [123-129] points vs 122 [118-126]; median difference, 4 points [95% CI, 2 to 5]; P = 0.001), but not for Group D1 vs Group N. However, no significant difference was observed in the global and dimensional QoR-15 scores on postoperative day 3 among the three groups. Intraoperative EEG power spectra analysis revealed a decrease in α oscillation peak power and an increase in slow oscillation peak power in Group D1 and Group D2, compared with Group N. In addition, the slow oscillation peak power exhibited weak positive correlations with QoR-15 scores on postoperative day 1 (r = 0.319, P < 0.001).

Conclusion: A loading dose of dexmedetomidine (0.5 μg/kg) infused within 10 minutes before anesthesia induction, followed by a maintenance at 0.6 μg/kg/h, improved QoR-15 on postoperative day 1 in elderly TKA patients, which may be partly related to the fact that dexmedetomidine deepens anesthesia by increasing the slow oscillation peak power in the appropriate range.

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来源期刊

Drug Design, Development and Therapy CHEMISTRY, MEDICINAL-PHARMACOLOGY & PHARMACY

CiteScore

9.00

自引率

0.00%

发文量

382

审稿时长

>12 weeks

期刊介绍： Drug Design, Development and Therapy is an international, peer-reviewed, open access journal that spans the spectrum of drug design, discovery and development through to clinical applications. The journal is characterized by the rapid reporting of high-quality original research, reviews, expert opinions, commentary and clinical studies in all therapeutic areas. Specific topics covered by the journal include: Drug target identification and validation Phenotypic screening and target deconvolution Biochemical analyses of drug targets and their pathways New methods or relevant applications in molecular/drug design and computer-aided drug discovery* Design, synthesis, and biological evaluation of novel biologically active compounds (including diagnostics or chemical probes) Structural or molecular biological studies elucidating molecular recognition processes Fragment-based drug discovery Pharmaceutical/red biotechnology Isolation, structural characterization, (bio)synthesis, bioengineering and pharmacological evaluation of natural products** Distribution, pharmacokinetics and metabolic transformations of drugs or biologically active compounds in drug development Drug delivery and formulation (design and characterization of dosage forms, release mechanisms and in vivo testing) Preclinical development studies Translational animal models Mechanisms of action and signalling pathways Toxicology Gene therapy, cell therapy and immunotherapy Personalized medicine and pharmacogenomics Clinical drug evaluation Patient safety and sustained use of medicines.